Credentialing System Administrator

ICBD Holdings LLC
US - Florida - Fort Lauderdale
December 17, 2024

DescriptionCredentialing System Administrator-Exact Billing SolutionsLauderdale Lakes, FLAbout Exact Billing Solutions

Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, and autism fields of healthcare services. We have extensive industry knowledge, a deep understanding of the specific challenges of these markets, and a reputation for innovation. With our proprietary billing process, EBS is the oil that brings life to the engines of its partner healthcare companies.

Growth Opportunity

If you're an experienced healthcare credentialing professional looking for a unique opportunity with a rapidly growing company, this could be a turning point in your career. Our Credentialing System Administrator plays a crucial role in ensuring that healthcare professionals within an organization meet all necessary qualifications, certifications, and regulatory requirements.

The Credentialing System Administrator is essential for managing and optimizing various systems, including credentialing, revenue cycle management (RCM), utilization review (UR), and electronic health records (EHR). This role involves ensuring that all system processes are efficient, accurate, and compliant with regulatory standards.

What You'll Do

System Management: Manage and optimize critical systems, including overseeing all aspects of system administration, such as configuration, implementation, updates, and troubleshooting for credentialing, revenue cycle management (RCM), utilization review (UR), and electronic health records (EHR). Oversee insurance and provider details, including Electronic Funds Transfers (EFTs).
Data Integrity: Ensure accuracy and completeness of systems data. Conduct regular audits to verify data quality, address discrepancies, and ensure compliance with regulations. Review files and records for completeness and correctness.
User Support: Address user issues and system errors promptly and effectively.
Compliance: Ensure all system processes and configurations adhere to industry regulations and company policies.
Integration: Collaborate with IT teams to integrate all systems with HR, compliance, and medical records systems.
Process Improvement: Assess and enhance all systems' workflow and functionality. Implement best practices and recommend improvements.
Documentation: Maintain comprehensive and current documentation for all system processes, system configurations, and user guides.
Collaboration: Work with leadership teams, IT departments, healthcare providers, and external agencies to ensure seamless operations.
User Accounts and Permissions: Manage user account creation, modification, deletion, and permissions to ensure appropriate access.
System Performance Monitoring: Monitor and track system performance using various tools, addressing any issues that arise and communicating issues to leadership as necessary.
Troubleshooting: Diagnose and resolve hardware, software, and network issues, including analyzing logs and running diagnostics.

RequirementsEducation/Experience and Other Requirements

Bachelor's degree in IT, Healthcare Administration, Business Administration, or a related field; master's degree preferred.
2+ years of experience working with healthcare system and payors.
Recent experience in credentialing, RCM, UR, and EHR processes and data management (preferred).
Certified Healthcare Compliance Specialist or another relevant licensure or certification (preferred).
Comprehensive understanding of credentialing processes, including initial credentialing, re-credentialing, and de-credentialing. Some understanding of Provider and EDI Enrollment process is helpful.
Must maintain clean background/drug screenings and driving record.

Expertise Needed

Proficiency in managing credentialing databases to track provider statuses.
Ability to generate, interpret reports, and identify trends relative to systems.
Proficiency with RCM, EDI ND credentialing systems, data management, and system integration.
Strong problem-solving abilities and capability to interpret complex data for actionable insights.
High accuracy in managing credentialing data and documentation.
Ability to handle multiple tasks, prioritize effectively, and maintain organized records.
Strong skills in managing projects and meeting deadlines.
Knowledge of conducting internal audits for compliance with policies and regulations.
Familiarity with standard contract terms and managing contracts with providers and payors.
Understanding of privacy laws like HIPAA and best practices for data security.
Commitment to handling sensitive information with confidentiality and ethical behavior.
Capability to maintain performance under pressure and tight deadlines.
Proactive approach to identifying improvements, addressing issues, and staying updated on industry changes.
Strong verbal and written skills for interacting with team members, providers, payors, and other stakeholders.
Ability to build positive relationships, demonstrate empathy, and negotiate effectively.
Familiarity with healthcare regulatory standards and guidelines, including those related to Applied Behavior Analysis and Substance Use Disorders.
Knowledge of terminology related to Applied Behavior Analysis and Substance Use Disorders.

Read the full job description and apply online on the recuiter's web-site

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